Individual
THERESA A. WITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
1900 S NATIONAL AVE, SUITE 3400, SPRINGFIELD, MO 65804-2265
(417) 820-3960
(417) 820-3966
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
089461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429413909
—
MO
01
—
431560263021
TRICARE
—
01
—
P00225992
RAILROAD MEDICARE
—
Enumeration date
11/27/2006
Last updated
07/11/2008
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